A breakdown of New York City’s new ‘universal health care’ plan

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New York City Mayor Bill de Blasio made a landmark announcement on Tuesday that the city would guarantee health care for all New Yorkers. The program, he said, would cost $100 million per year once fully implemented and involves two separate endeavors. One half will be an effort to increase enrollment in the city-owned insurance plan called MetroPlus, which the mayor said will begin immediately. The second half will be a program called NYC Care, which will provide those without insurance, estimated to be around 600,000 in the city, access to care. This includes people who cannot afford insurance, are ineligible for government health programs, including undocumented immigrants, and so-called “young invincibles,” healthy young people who feel they do not need insurance. The announcement was applauded by immigration advocates and progressive lawmakers as a significant step towards broader universal health care as single payer bills get debated in both the state and federal governments. But the proposal still requires some unpacking to fully understand what it is and what it will do.

So does this mean New York City will have single-payer health care?

The short answer is no. A single-payer system means there is only one plan, publicly run by the government, that everyone pays into and that in turns automatically covers health care costs for everyone. Such a system would be nearly impossible to impose on a municipal level. De Blasio’s proposal would be better described as universal access to health care, ensuring that everyone, even those who do not have insurance, can receive health care.

Then what is MetroPlus?

MetroPlus is an insurance plan owned and run by the city’s public hospital system, NYC Health + Hospitals. De Blasio called the plan a public option, but – while MetroPlus is run by a public entity – it still follows all the same rules as any other private insurance plans and competes against them in the market. It does, however, offer comparatively low-cost options. Half of de Blasio’s plan is simply to ramp up enrollment efforts to get more New Yorkers insured and improve the services it provides.

Is NYC Care insurance?

The second half of de Blasio’s proposal aims to help the uninsured receive necessary care, but it is not insurance. Those who enroll would receive an NYC Care card, a primary care doctor and a network of information for ease of access to care. Enrollees would pay fees on a sliding scale based on income, although the specifics still need to be worked out. Care would also be limited to the city’s public hospitals system, which is still the largest in the city. The goal, according to de Blasio, is to divert people away from emergency rooms, where costs run high, and instead have them visit primary care physicians who can address concerns before they warrant an emergency room visit.

And important note with this part of the proposal is that it does not introduce anything new. NYC H+H exists in part as a safety net system and takes anyone, regardless of insurance or immigration status. The city also already pays for these uninsured New Yorkers with large influxes of money into the system to help it stay afloat. The city paid $1.8 billion in subsidies to the system as part of the fiscal year 2019 budget. Additionally, H+H already provides a sliding scale pay option to those who want access to care through the system, called Options.

If all of this exists, what was the point of the announcement?

On a conference call with reporters, H+H Commissioner Mitchell Katz described NYC Care as “customer service,” which is an apt way to describe the proposal. While all the care options are in place, they are perhaps not being used, or are not being used in the most effective way possible. “We’re taking a system that historically has provided excellent medical and nursing care and we’re providing customer services that people actually know what they are entitled to and they’re able to receive it in a patient centered way,” Katz said. De Blasio also emphasized that when people know that they have access to care, they are more likely to seek it, and NYC Care would ensure that people know that they can go to public hospitals for their medical needs and have a network of information they can access for things like speciality care or to schedule an appointment with a different doctor if theirs is not available. Bill Hammond, health policy expert at the Empire Center, told City & State that the new health care proposal shows how broad health care access already is in the city. “It’s kind of highlighting how close we are to universal access already – especially in the five boroughs, where you have Health + Hospitals, a government financed health care system which, in principle, is there to treat people who need it, regardless of ability to pay,” Hammond said.

What will the $100 million be used for and where will it come from?

The money is an increase in H+H funding, one that is pretty much par for the course for the agency in recent years. It will come from directly from the city’s budget and will not require any new taxes to be imposed. Although the specific allocations remain in the works, the money will be used to cover the cost of the new customer support, as well as staffing changes to meet increased need.

Has this been done before?

San Francisco implemented an access-to-care plan for the uninsured in 2007 called Healthy San Francisco, which was the first of its kind in the nation. It offers sliding scale payment options based on the income of the individual and provides them with “medical homes” where participants receive primary care. As of 2017, a little under 14,000 people were enrolled, a far cry from the 600,000 people NYC Care could potentially reach. The architect of Healthy San Francisco is Katz, who now oversees the city’s public hospitals and is involved with the rollout of the mayor’s new plan.

New York City also had a short-lived pilot program called Action Health NYC to help undocumented immigrants get access to care. It cost $6 million and ultimately involved about 1,300 people. When asked about the pilot, as well as its cost, de Blasio said that NYC Care is a different concept, so it changes the approach and will have greater economies of scale.

When will this roll out?

Outreach efforts for MetroPlus enrollment will begin immediately, with new enhancements announced during the course of the year. NYC Care will launch in the Bronx this summer and will be in every borough by 2021.

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As founder and research director of the Empire Center for Public Policy, E.J. McMahon is a go-to expert on budget plans and policy proposals. His organization promotes greater transparency, accountability and fiscal responsibility in state government, which often puts him at odds with lawmakers and the governor. McMahon previously worked as a journalist in Albany, as an Assembly Republican staffer and a budget adviser for almost 30 years, giving him great insight into the goings-on in the Capitol.